<div class="row">
    <div class="col-md-12 widget-module">
        <div class="box-widget">
            <div class="widget-head clearfix">
                <h4 class="pull-left"><?php echo $this->translate('create user'); ?></h4>
            </div>
            
            <div class="widget-container">
                <div class="widget-block">
                    <div class="widget-content">
                        <form id="usergroup" method="post" class="form-horizontal form-box">
                            <div class="form-group <?php echo $this->classError['name']; ?>">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('name'); ?></label>
                                <div class="col-lg-6">
                                    <input class="form-control" type="text" value="<?php echo $this->data['name']; ?>" name="name" class="form-control" placeholder="<?php echo $this->translate('name'); ?>" />
                                    <?php echo $this->messageError['name']; ?>
                                </div>
                            </div>
                            
                            <div class="form-group <?php echo $this->classError['address']; ?>">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('address'); ?></label>
                                <div class="col-lg-6">
                                    <input class="form-control" type="text" value="<?php echo $this->data['address']; ?>" name="address" class="form-control" placeholder="<?php echo $this->translate('address'); ?>" />
                                    <?php echo $this->messageError['address']; ?>
                                </div>
                            </div>
                            
                            <div class="form-group <?php echo $this->classError['phone_number']; ?>">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('phone number'); ?></label>
                                <div class="col-lg-6">
                                    <input class="form-control" type="text" value="<?php echo $this->data['phone_number']; ?>" name="phone_number" class="form-control" placeholder="<?php echo $this->translate('phone number'); ?>" />
                                    <?php echo $this->messageError['phone_number']; ?>
                                </div>
                            </div>
                            
                            <div class="form-group <?php echo $this->classError['email']; ?>">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('email'); ?></label>
                                <div class="col-lg-6">
                                    <input class="form-control" type="text" value="<?php echo $this->data['email']; ?>" name="email" class="form-control" placeholder="<?php echo $this->translate('email'); ?>" />
                                    <?php echo $this->messageError['email']; ?>
                                </div>
                            </div>
                            
                            <div class="form-group <?php echo $this->classError['username']; ?>">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('username'); ?></label>
                                <div class="col-lg-6">
                                    <input class="form-control" type="text" value="<?php echo $this->data['username']; ?>" name="username" class="form-control" placeholder="<?php echo $this->translate('username'); ?>" />
                                    <?php echo $this->messageError['username']; ?>
                                </div>
                            </div>
                            
                            <div class="form-group <?php echo $this->classError['password']; ?>">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('password'); ?></label>
                                <div class="col-lg-6">
                                    <input class="form-control" type="password" value="" name="password" class="form-control" placeholder="<?php echo $this->translate('password'); ?>" />
                                    <?php echo $this->messageError['password']; ?>
                                </div>
                            </div>
                            
                            <div class="form-group <?php echo $this->classError['repassword']; ?>">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('repassword'); ?></label>
                                <div class="col-lg-6">
                                    <input class="form-control" type="password" value="" name="repassword" class="form-control" placeholder="<?php echo $this->translate('repassword'); ?>" />
                                    <?php echo $this->messageError['repassword']; ?>
                                </div>
                            </div>
                            
                            <div class="form-group">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('status'); ?></label>
                                <div class="col-lg-4">
                                    <div class="checkbox">
                                        <label>
                                            <input <?php if($this->data['status']) echo 'checked="checked"'; ?> type="checkbox" name="status" value="1" />
                                            <?php echo $this->translate('active'); ?>
                                        </label>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="form-group">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('block'); ?></label>
                                <div class="col-lg-4">
                                    <div class="checkbox">
                                        <label>
                                            <input <?php if($this->data['block']) echo 'checked="checked"'; ?> type="checkbox" name="block" value="1" />
                                            <?php echo $this->translate('block'); ?>
                                        </label>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="form-group">
                                <label class="col-lg-2 control-label"><?php echo $this->translate('role'); ?></label>
                                <div class="col-lg-4">
                                    <div class="checkbox">
                                        <label>
                                            <input <?php if($this->data['role']) echo 'checked="checked"'; ?> type="checkbox" name="role" value="1" />
                                            <?php echo $this->translate('role'); ?>
                                        </label>
                                    </div>
                                </div>
                            </div>
                            
                            <div class="form-group">
                                <label class="col-lg-2 control-label">&nbsp;</label>
                                <div class="col-lg-4">
                                    <div class="form-actions">
                                        <button id="save" type="submit" class="btn btn-primary">
                                            <i class="icon-save"></i>
                                            <?php echo $this->translate('save'); ?>
                                        </button>
                                    </div>
                                </div>
                            </div> 
                            <?php if(isset($this->data['id']) && $this->data['id'] > 0): ?>
                            <input type="hidden" name="id" value="<?php echo $this->data['id']; ?>" />
                            <?php endif; ?>
                        </form>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>